title: Substituting community children's nursing services for inpatient care: a case study of costs and effects.
abstract: OBJECTIVE
  To compare children's pathways to and through Community Children's Nursing Team (CCNT) care, and NHS costs, before and after relocation of inpatient services and extension of a paediatric Emergency Department and Observation and Assessment Unit (ED/OAU).
  
  
  METHODS
  Case study. Routinely collected data on activity and staffing were provided by the CCNT. Parents completed questionnaires about their child's use of healthcare services and satisfaction with care preservice reconfiguration (n=221) or postreconfiguration (n=210). The cost of service use was compared prereconfiguration and postreconfiguration.
  
  
  METHODS
  Children referred to CCNT care.
  
  
  METHODS
  Healthcare service use and associated costs, satisfaction with CCNT care.
  
  
  RESULTS
  The mean number of services used before referral to the CCNT reduced from 2.8 to 1.6, and the proportion using only one service increased from 26% (n=58) to 61% (n=128). Inpatient admission during CCNT care reduced from 6% (n=13) to 2% (n=4), and ED attendance from 37% (n=79) to 16% (n=31). There was a considerable fall (25%) in the cost of CCNT care, and a sharp fall (55%) in the average overall NHS cost of care. CCNT care was rated 'excellent' or 'very good' by 85% of respondents both prereconfiguration and postreconfiguration.
  
  
  CONCLUSIONS
  A CCNT provided an alternative to hospitalisation when acute general paediatric services were reconfigured to substitute for a relocated hospital. Children's pathways to CCNT care were shortened. The average cost of CCNT care and overall NHS cost were lower following reconfiguration. Satisfaction remained high throughout.
authors.affiliation: School of Nursing, Midwifery and Social Work, The University of Manchester, Manchester Academic Health Science Centre, Manchester, UK.
authors.forename: Peter
authors.initials: P
authors.lastname: Callery
authors.affiliation: School of Nursing, Midwifery and Health, University of Stirling, Stirling, UK.
authors.forename: Richard G
authors.initials: RG
authors.lastname: Kyle
authors.affiliation: Centre for Health Economics, University of York, York, UK.
authors.forename: Helen
authors.initials: H
authors.lastname: Weatherly
authors.affiliation: School of Nursing, Midwifery and Social Work, The University of Manchester, Manchester Academic Health Science Centre, Manchester, UK.
authors.forename: Michele
authors.initials: M
authors.lastname: Banks
authors.affiliation: Royal Manchester Children's Hospital, Central Manchester University Hospitals NHS Foundation Trust, Manchester, UK.
authors.forename: Carol
authors.initials: C
authors.lastname: Ewing
authors.affiliation: Paediatric Department, West Suffolk Hospital, Bury St Edmunds, Suffolk, UK.
authors.forename: Peter
authors.initials: P
authors.lastname: Powell
authors.affiliation: School of Nursing, Midwifery and Social Work, The University of Manchester, Manchester Academic Health Science Centre, Manchester, UK.
authors.forename: Susan
authors.initials: S
authors.lastname: Kirk
mesh_terms: D000293:Adolescent; D002648:Child; D002662:Child Health Services / Q000458:organization & administration*; D002675:Child, Preschool; D019091:Critical Pathways; D004636:Emergency Service, Hospital / Q000458:organization & administration*; D017048:Health Care Costs; D006760:Hospitalization; D006801:Humans; D007223:Infant; D009746:Nursing, Team / Q000458:organization & administration*; D019982:Organizational Case Studies; D010290:Parents / Q000523:psychology; D017060:Patient Satisfaction; D011795:Surveys and Questionnaires; D006113:United Kingdom
keywords: nursing; paediatrics